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Tsukamurella endocarditis and leucopenia: case report A 52-year-old woman developed Tsukamurella endocarditis during treatment with cisplatin and etoposide for small cell carcinoma of the left lung. Additionally, she developed leucopenia following treatment with cisplatin and etoposide [time to reactions onsets not stated]. The woman, who had a history of chronic obstructive pulmonary disease, depression, hepatitis C and anxiety, was diagnosed with small cell carcinoma of the left lung in April 2019. She started receiving immunosuppressive chemotherapy with cisplatin and etoposide for a total of 6 cycles, 21 day per cycle [dosages and routes not stated]. On 26 August 2019, she was admitted for hypokalaemia [aetiology not stated] and routine cultures from peripheral blood and port were drawn on admission. After 2 days, she was discharged from the hospital. The blood cultures grew a gram-positive rod on day 8 (i.e on 3 September 2019), which was unidentifiable at the hospital laboratory. Hence, the culture was sent to another laboratory. On 16 September 2019, the culture was identified as Tsukamurella pulmonis/spongiae. She was asymptomatic and presented on 20 September 2019 to receive her final cycle of chemotherapy. The woman’s chemotherapy was interrupted. Following discussion with her oncologist, she was admitted to another hospital. On admission, she was afebrile. She also had cold, chills and nausea since the past few days, which she assumed was secondary to the chemotherapy. Then, her port was covered with dressing and gauze. She remained stable on her oxygen supplement. Laboratory tests revealed absolute neutrophil count 1056 /uL consistent with leucopenia (WBC count 2200 /µL), which was attributed to the chemotherapy. On 30 September 2019, blood cultures from port and right arm were drawn. She was treated with imipenem. Repeat peripheral blood cultures grew gram-positive rods and were identified as Tsukamurella species in one of four bottles only. On 01 October 2019, the port was removed. On 02 October 2019, repeat blood cultures revealed no growth with clearance of bacteraemia. On 07 October 2019, a transesophageal echocardiogram was performed, which showed aortic valve vegetation. A diagnosis of endocarditis was made. Hence, she was treated with cotrimoxazole [trimethoprim-sulfamethoxazole]. On day 8, she remained afebrile and showed clinical improvement. On 08 October 2019, she was discharged with a 6-week course of imipenem and cotrimoxazole. She was followed-up with no further issues and completed her antibiotic course. Malik Z, et al. First report of Tsukamurella endocarditis in an immunocompromised patient receiving chemotherapy. European Journal of Clinical Microbiology and Infectious 803518320 Diseases 39: 1989-1991, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1007/s10096-020-03917-5

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Reactions 5 Dec 2020 No. 1833